Weekday Registration/Freedom Aquatic Center 2008-2009
(to print, right-click this page and select print)
Please make checks payable to:
Riptide Swim Team
Mail registration form and payment to:
Shandra Richardson
6712 Jackpin Place
Gainesville, VA 20155
FAMILY NAME
LAST NAME
FIRST NAME
STREET
CITY
STATE
ZIP
HOME PHONE
FATHER WORK
MOTHER WORK
FATHER CELLULAR
MOTHER CELLULAR
FAMILY EMAIL
EMERGENCY
CONTACT
EMERGENCY PHONE
SWIMMERS
LAST NAME
SUMMER CLUB
FIRST NAME & MIDDLE INT. FOR EACH
SWIMMER
1
2
3
4
DOB
SEX
AGE
DOB
SEX
AGE
DOB
SEX
AGE
DOB
SEX
AGE
50yd freestyle time:
50yd freestyle time:
50yd freestyle time:
50yd freestyle time:
T-Shirt Size:
T-Shirt Size:
T-Shirt Size:
T-Shirt Size:
WORKOUT DAYS &
TIME:
WORKOUT DAYS &
TIME:
WORKOUT DAYS &
TIME:
WORKOUT DAYS &
TIME:
PAYMENT:
Additional swimmers receive 10% discount ($385 1 x a week,
$700 2 x's a week, $1000 3 x's a week, *High-School Prep $280 1 x a week,
$570 2 x's a week )
TOTAL AMOUNT
FOR SWIMMER 1
TOTAL AMOUNT
FOR SWIMMER 2
TOTAL AMOUNT
FOR SWIMMER 3
TOTAL AMOUNT
FOR SWIMMER 4
Payment Contract:
Upon
acceptance into any of the Riptide Swim Team programs, both my swimmer(s)
and I agree to abide by all team rules. I understand that I am obligated
to pay the full program fees as indicated.I understand my child will be prohibited from taking part in any
team practice, meet, or activity if I fail to make payments in a timely
manner.
TOTAL AMOUNT FOR FAMILY $
__________._____
$55.00 non-refundable
registration fee per
swimmer due upon Registration (not part of total fee).
